Health systems around the world are challenged by an ageing population, increasing rates of chronic disease, rising consumer expectation and the introduction of new technologies and treatments.
The Agency for Clinical Innovation (ACI) hosted a think tank on 28 October for healthcare professionals and managers working in the NSW Health system. Titled the Science of Large Systems Change – Research Think Tank, this event encouraged critical debate on how to support transformative change across the NSW health system.
In order to share the main findings of this event, Maeve Eikli, Director Engagement, Executive Support and Communications from ACI, has prepared the following summary of the main speakers, which includes with links to their Powerpoint presentations, videos and also a rapid review of the evidence and stakeholder interviews.
Keynote speaker, Professor Allan Best from the School of Population and Public Health, University of British Columbia outlined five simple rules to guide transformative change in large complex health systems. These included (1) the value of top down bottom up transformative leadership (2) the importance of measurement, rapid feedback and reporting (3) an understanding that transformation takes place in an historical context (4) identifying how to engage and share power to facilitate practice change and (5) support for person centred care at the coalface.
Professor Jeffrey Braithwaite, Director, Australian Institute for Health Innovation, UNSW said that partnerships are key to the success of interventions in the health system and emphasised the need for evaluation.
Prof Rick Iedema, Director, Centre for Health Communication, UTS, Sydney talked about complexity at the front line, and said that embedded habits need to be acknowledged by the individuals themselves before behavioural change can occur.
Professor Enrico Coiera, Director, Centre for Health Informatics, Australian Institute of Health Innovation, University of NSW explained that people are inherently pro-innovation which can lead to complexity and systems inertia. He suggested that the health system would benefit from a form of ‘apoptosis’, which in biological systems makes way for new cells.
Dr Rory Gallagher, Advisor on Behavioural Insights, NSW Department of Premier and Cabinet shared his experience from the UK, and talked about the importance of making change the easy option, the value of rewards and understanding local context.
Dr Julien Pollack, Senior Lecturer, School of the Built Environment, UTS, Sydney revealed that people look for what’s familiar or comfortable, when faced with complexity which may be structural, technical, directional or temporal.
Mr Rodger Watson, Deputy Director, Designing Out Crime Research Centre, UTS, Sydney talked about innovation as a scale from incremental to radical and outlined how design is used as a tool in crime change initiatives. He outlined the process his centre used to partner, understand the context and frame their approach to transformation.
‘We need to continually look at innovative ways of delivering health care to patients and understand how to effect and sustain change initiatives across the health system”, said Dr Nigel Lyons, ACI Chief Executive.
Key points raised in panel discussions included:
- The complex health systems of today require that we move away from hypothesis driven research to problem solving research
- An awareness of local context is critical
- To allow space and sufficient resources for innovation, we need to consider what existing processes could be stopped or ‘turned off’
- A common language and common vision and partnerships are essential to realising transformative change.
- Co-creation should include networks of clinicians, health managers, governments, NGOs, researchers, consumers and the community
- Robust, timely and relevant evaluation and greater efforts to utilise existing data sources and infrastructures, including data linkage and cohorts is needed
- There is great potential to learn from other sectors who are tackling complex problems in complex systems
- Tools and methods such as complexity theory, framing, design and learning laboratories may be of value to the NSW health system and to the initiatives of the ACI.
Dr Lyons explained that the ACI has embarked on a program of research to better understand how to ‘scale up’ small, locally effective innovations to achieve large system change initiatives across NSW Health.
“Today’s think tank has helped challenge established beliefs and kick start an important conversation with health system leaders. By learning from other industries we can develop a shared understanding to improve integration and innovation and generate sustainable change across the NSW health system”, said Dr Lyons.
To read more, including indepth interviews with stakeholders and a rapid review of the drivers of large-scale change, visit the ACI website at: